Fraser Forum - July/August

A Fraser Institute review of public policy in Canada

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ALSO IN THIS ISSUE

Fat taxes

Reducing governmenthealth costs

Tax Freedom Day

Fraser Forum

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Fraser Institute Board of Trustees Peter Brown (Chairman), Brad Bennett (Vice Chairman), Paul Fletcher (Vice Chairman), Mark W. Mitchell (Vice Chairman), Salem Ben Nasser Al Ismaily, Gordon E. Arnell, Kathy Assayag, Ryan Beedie, Edward Belzberg, Joseph C. Canavan, Alex A. Cha-fuen, Derwood Chase, Jr., James W. Davidson, John Dielwart, Stuart Elman, Dave Filmon, Greg C. Fleck, Shaun Francis, Ned Goodman, John A. Hagg, Paul Hill, Stephen A. Hynes, Charles A. Jeannes, C. Kent Jespersen, Andrew Judson, Robert H. Lee, Brandt Louie, David MacKenzie, James McGovern, George Mel-ville, Gwyn Morgan, Eleanor Nicholls, Roger Phillips, Herb C. Pinder, Jr., R. Jack Pirie, Kevin Reed, H. Sanford Riley, Gavin Semple, Rod Senft, Anthony Sessions, William W. Siebens, Anna Stylianides, Arni C. Thorsteinson, Michael A. Walker, Jonathan Wener, Brett J. Skinner (President), Peter Cowley (Senior Vice President, Operations), Niels Veldhuise (Vice President, Re-search), Fred McMahon (Vice President, Research), Michael Perri (Secretary-Treasurer)

From the editor

www.fraserinstitute.org Fraser Forum July/August 2011 1

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Minimize government intervention

Minimizing government intervention is a familiar theme throughout many Fraser Institute publications, and in this particular issue of Fraser Forum, it is government intervention specifically in the field of

housing finance that forms our feature story. In “Government participation in housing finance: the case for CMHC withdrawal keeps becoming stronger” (pg. 10), Neil Mohindra outlines the concerns and risks that come with having the Canada Mortgage and Housing Corporation (CMHC)—a crown corporation—involved in housing finance. The concerns of the article, as well as Neil’s larger study, Mortgage Finance Reform: Protecting Taxpayers from Liability, revolve largely around the degree to which government intervention in the mortgage insurance market unnecessarily exposes the Canadian taxpayers to financial liabilities should a collapse in the housing market occur. Accordingly, he argues, the Canadian government should “eliminate its support for the residential mortgage market.”

Other articles in this issue of Fraser Forum also raise questions about the extent of government involvement at the provincial level as well. In “Ontario should replace age-based drug subsidies” (pg. 16), Mark Rovere and Bacchus Barua argue that the Ontario government should eliminate its age-based policy on drug subsidies because the predetermined age of 65 is a poor indicator of need. Rather, they claim, means-tested eligibility is a much more sound practice that would generate significant savings for Ontario.

Also included in this issue of Fraser Forum is a commentary about the role of the World Bank in the palm oil industry in Liberia. Thompson Adoyele’s article “Banking on Liberia’s future” (pg. 8) claims that “the World Bank’s suspension of palm oil funding undermines its historical mandate of poverty alleviation through agricultural development in the developing world.”

Finally, we once again end with an article in our regulation series; in this issue, Nadeem Esmail writes about the misguided support for a “Fat Tax” (pg. 24), claiming that it is not the appropriate policy tool to deal with the rising prevalence of obesity and poor diet. Are “targeted solutions that require the obese to take responsibility for the health costs created by their lifestyle choices” actually a smarter solution? Cari A. Ferguson ([email protected])

2 Fraser Forum July/August 2011 www.fraserinstitute.org

Contents

Fraser Forum

5Tax Freedom Day

24“Fat Taxes”

16Age-based drug subsidies

1 From the editor

4 Forum authors

5 A great entrepreneurial idea or not? The public-private partnership between IMS Health and the Canada Pension PlanDr. Gordon Atherley

The public-private partnership between IMS Health and the Canada Pension Plan has raised strong concerns about patient privacy and data mining.

8 Banking on Liberia’s futureThompson Ayodele

The World Bank’s suspension of palm oil funding undermines its historical mandate of poverty alleviation through agricultural development in the developing world.

10 Government participation in housing finance: the case for CMHC withdrawal keeps becoming strongerNeil Mohindra

The Canadian government needs to withdraw from its backing of the residential mortgage market and should eliminate Canada’s exposure to the mortgage finance market before, rather than after, a crisis.


13 Canadians celebrated Tax Freedom Day on June 6th

Milagros Palacios and Niels Veldhuis

Read a summary of the 2011 Tax Freedom Day report, which provides a comprehensive and easily understood indicator of the overall tax burden faced by the average Canadian family.

16 Ontario should replace age-based drug subsidiesMark Rovere and Bacchus Barua

Provinces could achieve significant savings by replacing aged-based eligibility criteria for public drug plans with means-tested eligibility for catastrophic coverage.

20 Alberta heads back to the 1980sMark Milke

Alberta needs to be careful not to repeat the trend of consecutive deficits experienced by the province in the late 1980s and early 1990s.

24 Taxing pop and butter won’t necessarily make Canadians skinnyNadeem Esmail

“Fat taxes” are not the appropriate policy tool to deal with the rising prevalence of obesity and poor diet.

Feature Story

CMHC and housing finance—page 10


Forum Authors

M a r k M i l k e (m a r k . m i l k e @fraserinstitute.org) is director of the Fra-ser Institute’s Alberta office and of the Alberta Prosperity Project, www.fraserin-stitute.org. He has a Ph.D. in International Relations and Political Philosophy from the University of Calgary.

N i e l s Ve l d h u i s (n ie l s .veld hu [email protected]) is the director of f iscal studies and vice-president, Canadian policy research, at the Fraser Institute. He has an M.A. in economics from Simon Fraser University.

Milagros Palacios ([email protected]) is a senior economist with the Fraser Institute’s fiscal studies department. She holds an M.Sc. in economics from the University of Concep-cion in Chile.

M a r k r o V e r e (m a r k . r o v e r e @fraserinstitute.org) is the associate direc-) is the associate direc-tor of the Health Policy Research Centre at the Fraser Institute. He holds an M.A. in political science from the University of Windsor.

Ba cc h u s Ba r u a ( bacchus .ba r [email protected]) is an Economist in the Centre for Health Policy Studies. He com-pleted his B.A. degree in economics at the University of Delhi, and received an M.A. in Economics from Simon Fraser University.

NadeeM esMail is a senior fellow and a for-mer director of Health System Performance Studies at the Fraser Institute. He holds an M.A. in economics from the University of British Columbia.

Neil MohiNdra ([email protected]) is the Director of the Centre for Financial Policy Studies at the Fraser In-stitute. He holds a BA (Honours) in Social Sciences (Economics) from the University of Ottawa and an MBA in Finance from McGill University.

dr. gordoN atherley holds the British equivalents of the North American PhD and MD degrees, and LLD, Honoris Causa, from Canada’s Simon Fraser University. Prior to retiring from medical practice, his specialties were occupational medicine and public health.

thoMPsoN ayodele is the Director of Initiative for Public Policy Analysis, a public policy think tank promoting the institu-tions of free society based in Lagos, Nigeria. He attended Obafemi Awolowo University, Ile-Ife, Nigeria, where he got a degree in humanities, and Kwara State Polytechnic, Ilorin, Nigeria, where he also received his Diploma in Law. Prior to his work with IPPA Nigeria, he was a journalist with The Comet.

Contributors


dr. gordoN atherley

The Canada Pension Plan In-vestment Board (CPPIB) and TPG Capital, a global private

investment firm, acquired IMS Health in a $5.2 billion transaction, complet-ed early in 2010 (IMS Health, 2010). IMS Health is now a private company named IMS in the US with a Canadian unit, IMS | Brogan.

CPPIB is a Canadian federal Crown corporation purposed solely with investing the assets of the Canada Pension Plan to maximize returns with-out undue risk of loss. Begun in 1966, the Canada Pension Plan is adminis-tered chiefly by Human Resources and Skills Development Canada.

IMS says it processes billions of health care transactions each year. And that it captures information about more than 260 million anonymized pa-

A great entrepreneurial

idea or not

?The public-private partnership between IMS

Health and the Canada Pension Plantients worldwide, including diagnosis and treatment (IMS Health, 2011).

Here is a public-private part-nership raising revenue for a major government program, surely a great entrepreneurial idea—but is risk signalled by the US Supreme Court lawsuit, Sorrell v. IMS Health, Inc.? (It had been heard but not decided as of this writing.) Cornell Univer-sity’s Legal Information Institute summarizes the lawsuit as follows: in 2007 Vermont passed Act 80, which prohibits prescription drug companies from obtaining patients’ personal information for marketing purposes without the prescribing physician’s consent. The pharma-ceutical companies sued the state of Vermont, seeking an injunction prohibiting the enforcement of Act 80 on the grounds that it was an un-

constitutional restriction on their rights to commercial speech. Ver-mont disagrees and argues that the law is related to Vermont’s interests of protecting medical privacy, pro-tecting public health, and control-ling health care costs (Cornell, 2011).

The blog of the Supreme Court of the United States published the Brief for The United States as Am-icus Curiae Supporting Petitioners, which urges that the judgment of the court of appeals should be reversed, as do another 25 organizations and groups, including one composed of 35 US states. The Brief explains that pharmacies sell prescriber-identifiable data to data-mining companies like IMS Health. It also says that companies like IMS Health receive patient-identi-fiable data, a statement not immedi-ately reconcilable with IMS’ charac-


terization of 260 million patients as anonymized (Scotusblog, 2011).

Data mining caused legal chal-lenges in Canada, too. In 2010, the Canadian Medical Association Jour-nal reported the purchase of IMS Health (Silversides, 2010). Ann Sil-versides notes the history of concern by Canadian physician organizations about IMS Health’s prescription data mining. She reports that the Canadi-an Medical Association was granted intervener status in an unsuccessful appeal of the federal Privacy Com-missioner’s 2001 decision that physi-cian prescribing information is not personal information.

Risks associated with privacy of patients’ personal information are acknowledged by IMS Health in its 2010 form 10-K submission to the US Securities and Exchange Com-

mission. The submission recog-nizes that data protection and pri-vacy laws may restrict IMS Health’s current and future activities, which would affect its collection, use, storage, and transfer of personally identifiable information in the US and abroad. It notes that failure to comply with such laws may for IMS Health result in “civil and criminal liability, negative publicity, data be-ing blocked from use and liability under contractual warranties” (IMS Health Inc., 2010). It perceives in-

on a large scale anywhere in the world” (Royal College of General Practitioners et al., 2011). As of early 2011, the UK’s framework for data sharing using elec-tronic patient records was undecided.

In Canada, by contrast, public policy emphasizes sharing of patient records through linking electronic health record (EHR) systems. Federal health Minister Leona Aglukkaq ex-plains that the role of Canada Health Infoway, a federal foundation, with the federal government’s support, is to ensure that such systems “will one day be compatible across Canada” (Agluk-kaq, 2011). She adds that new systems co-funded through Infoway require compliance with its set standards.

Infoway’s standards insist that electronic medical records (EMRs), typically held in physicians’ offices, provide essential information for capture in EHRs. The EMRs, says Infoway, will draw information from the EHR repositories and contribute information back. Together the EMR and EHR should provide comprehen-sive patient information to authorized health care providers (Canada Health Infoway, 2011). In Canadian public policy, “health care provider” means any person or organization authorized by government, and that the EMR-EHR flow is automated even to the extent that neither physicians nor pa-tients may not be aware of the flow or its contents.

A covert and socially risky use of information technology, track-ing, and surveillance, is attracting attention in Europe. Tracking and surveillance with information tech-nology is designed into the Ontario government’s Diabetes Registry oper-ated by eHealth Ontario, an Ontario government agency (eHealth Ontario, 2011). The registry uses existing pro-vincial databases, such as the Ontario Laboratories Information System and the Ontario Claims Database, to con-tinually identify patients newly diag-nosed with diabetes and to capture laboratory results and dates. Which organizations and persons are able to

creasing public concern regarding data protection and privacy issues, and observes that jurisdictions with data protection and privacy laws have been increasing.

Concerns about risks to pri-vacy in the electronic world are expanding in Europe. In its 2008 Judgment, I v. Finland, the Euro-pean Court of Human Rights exam-ined Article 8 of the EU’s Convention for the Protection of Human Rights and Fundamental Freedoms. In the Court’s assessment, Article 8 does not merely compel the State to abstain from arbitrary interference by “public authorities”: there may also be “posi-tive obligations inherent in an effective respect for private or family life” (Eu-ropean Court of Human Rights, 2008).

England’s original objective was a health-service-wide single

electronic record for each patient. The record was to be accessible by the family doctor, other communi-ty-based health care providers and local hospitals. But doubts grew as concerns mounted about privacy and consent, and security lapses in other national information technology projects. Doubts arose about the ben-efits of electronic patient records be-cause the “anticipated improvements in efficiency, safety, equity, and cost-effectiveness of care have not been realized in the few rigorous studies


access the registry is currently unclear. Could the registry’s data on a million or so identifiable Ontarians with diabetes be sold complete with patient-identifiable information to data-mining companies like IMS?

How Canada compares to Eu-rope and the US in attitudes to privacy is hinted at in the response to the Cana-dian Medical Association’s Principles for the Protection of Patients’ Personal Health Information published early in 2011. One of its stipulations is that

“patients should be informed that the treating physician cannot control ac-cess and guarantee confidentiality for an electronic health record (EHR) sys-tem” (Canadian Medical Association 2011). Explorations of the response to the policy suggest that it has been ignored by Canada’s EHR officialdom. The attention it received is limited to groups and individuals with special-ized interests. Of Ontario’s 24 regulated health professions’ associations, none of-fered the public any indication of any at-tention by the association’s member pro-fessionals to the privacy of their patients/clients’ personal health information held in electronic form (Atherley, 2011).

Time will tell whether the public-private partnership between IMS

Health and the Canada Pension Plan was a great idea. But clear already is that in substantial marketplaces for IMS, the US, and Europe, concerns about patient privacy and data mining are strengthening in trends which could create social environments adverse to data mining activities by governments and not only private companies like IMS. And Canada’s governments ap-pear to be out of sync with their US and European counterparts on electronic health record privacy and health data mining.

References

Aglukkaq, Leona (2011). Minister of Health. Personal Communication, June 7, 2011.

Atherley, Gordon (2011). Privacy, EHRs and Ontario’s Health care Profes-sions’ Professionalism. <http://www.taxonomer.com/PublishTxgd001/Privacy%20Policy/index.htm>, as of June 18, 2011.

Canada Health Infoway (2011). How EMRs Relate to the EHR. <http://www.infoway-inforoute.ca/lang-en/working-with-ehr/health-care-pro-viders/emrs>, as of June 18, 2011.

Canadian Medical Association (2011). Principles for the Protection of Pa-tients’ Personal Health Information.

Cornell (2011). Cornell University’s Legal Information Institute: Sorrell v. IMS Health, Inc. (10-779). <http://topics.law.cornell.edu/supct/cert/10-779>, as of June 18, 2011.

eHealth Ontario (2011). Diabetes Regis-try and Portal. <http://www.ehealth-ontario.on.ca/programs/index.asp>, as of June 18, 2011.

European Court of Human Rights (2008). Case of I v. Finland, Judgment, Strasbourg, 17 July 2008.

IMS Health (2010). IMS Health An-nounces Completion of Acquisition by Affiliates of TPG and the CPP In-vestment Board.

IMS Health (2011). Powerful Capabili-ties. <http://www.imshealth.com/portal/site/imshealth/menuitem.a953aef4d73d1ecd88f611019418c22a/?vgnextoid=2dbe51dd68585110VgnVCM10000071812ca2RCRD&vgnextfmt=default>, as of June 18, 2011.

IMS Health Inc. (2010). Form 10-K. <http://www.faqs.org/sec-filings/100217/IMS-HEALTH-INC_10-K/>, as of June 18, 2011.

Royal College of General Practitioners, British Medical Association, and De-partment of Health (2011). The Good Practice Guidelines for GP Electronic Patient Records v4.

Scotusblog (2011). Supreme Court of the United States Blog. Brief for The United States as Amicus Curiae Sup-porting Petitioners. <http://www.scotusblog.com/case-files/cases/sorrell-v-ims-health-inc/>, as of June 18, 2011.

Silversides, Ann (2010). Canada Pen-sion Plan buys IMS Health Canadian Medical Association Journal. January 12, 2010, 182(1), as of June 18, 2011.

Is it ethical to commoditize

highly private medical information?


The growth of the palm oil in-dustry in Liberia is a textbook case of how developing coun-

tries can harness trade, capital formation, and technology to rise from poverty to prosperity. Policy makers must understand what is at stake to keep Liberia’s advancement on track. Recently, Equatorial Palm Oil, a London-based company that concentrates its activities in Liberia, announced it has completed a ma-jor palm oil processing mill. This is a significant step in the ongoing devel-opment of Liberia’s palm oil sector.

The mill, located about 160 km southeast of Monrovia, was designed by Modipalm Engineering Sdn Bhd, a Malaysian manufacturer of palm oil mills. The announcement of the mill’s completion follows just a few months after the Liberian govern-ment announced US$1.6 billion in direct foreign investment from Golden-Agric Resources in Liberia’s palm oil sector. This was among the

Banking onLiberia’s future

thoMPsoN ayodele

single largest agriculture invest-ments in Liberian history.

All of this activity validates Li-beria’s development strategy, one that embraces foreign investment and capital formation to bring bad-ly needed resources and industrial capacity to boost Liberian produc-tivity. As Liberia’s palm oil industry has grown, the resulting job boom is extraordinary. There are now over 220,000 small holders of palm oil land in Liberia, earning enviable incomes. The recent investment by Golden-Agric Resources will help create an additional 35,000 new jobs. It is expected the new process-ing mill will add more.

It is also a validation of the poli-cies pursued by World Bank execu-tives just a generation ago. Begin-ning in the 1970s, the World Bank extended loans to Liberia’s nascent palm oil entrepreneurs in an effort to kick-start plantation-scale agri-culture. The loans were helpful to re-

suscitate Liberia’s palm oil industry. But that beneficial process is being challenged by missteps at the World Bank and other Western-based envi-ronmentalist organizations.

The World Bank’s mission is poverty alleviation. It thus has long believed that loans to support agric-business enterprises were a smart bet. Emerging agric-business in the developing world would pro-vide jobs, but many have beneficial spillover effects as well. These in-clude the ability to trade in global markets, attract foreign investment, and enable badly needed technology transfer that would boost food yields and enhance economic growth.

All of that has been realized in Liberia, a previously war-torn coun-try that is becoming one of the jew-els of Africa. The palm oil industry has been a vital engine for lifting poor Liberians out of poverty.

But recently the World Bank has harboured second thoughts about


palm oil. At the behest of environ-mental organizations in the Western World, it initiated a suspension and review of its lending practices to palm oil projects around the world. The green NGOs wrongly believe that palm oil development harms wildlife and leads to deforestation.

While deforestation is a prob-lem in countries such as my native Nigeria, the destruction of forests is happening in regions where there is no palm oil development. The forest depletion in Liberia and other Afri-can countries is generally due to the poor’s reliance on firewood for fuel. Indeed, countries such as Malaysia, where half the nation’s forests are preserved, demonstrate that there need be no tension between palm oil development and ecological health.

The World Bank’s suspension of palm oil funding undermines its historical mandate of poverty al-leviation through agricultural de-velopment in the developing world.

This marks a worrisome evolution of its priorities. It is moving away from fostering wealth creation and toward extending a regime of en-vironmental regulation dictated by vested interests. Such an evolution should not be seen as friendly to the developing world.

It is ironic that the Work Bank is making a U-turn at a time when oth-er African countries are capitalizing on palm oil to grow their economies. The International Fund for Agricul-tural Development (IFAD) recently announced a US$50 million loan to Uganda’s booming palm sector. This loan provides direct benefits to more than 136,000 Ugandan families and local businesses. The IFAD rightly sees palm oil investment as crucial for economic development; the World Bank would be well-served to follow this agency’s example.

The World Bank has issued updated guidelines with respect to palm oil plantation agriculture. A

new framework was submitted to the World Bank Group’s Management Board for its approval by March 2011, after hearing first from public stakeholders. If the World Bank ex-tends its suspension, it would hurt Liberia’s access and availability to an important food source. It would also have long-term consequences for Liberia’s broader development as it would be particularly harmful to-wards small farmers and landhold-ers, a significant portion of Liberia’s rising middle class of consumers. It is not too late for the World Bank to put people and progress first ahead of narrow Western political interests

A previous version of this article was published in the Liberian Observer on January 26, 2011.

Flikr


Government participation in housing finance:

The case for CMHC withdrawal keeps becoming stronger


A Fraser Institute study on mortgage finance published in 2010 examined mortgage fi-nance systems in Canada and other countries; it concludes that not only are government-backed insurance or guarantees not needed

for a home mortgage finance industry to operate success-fully, but that exposure to this industry has adverse conse-quences when a crisis happens (Mohindra, 2010). Where there is government backing in place, taxpayers will receive a very nasty bill when a crisis happens for covering the cost of mortgage defaults, and that bill will likely arrive in the midst of a recession alongside all the financial strains a re-cession creates. In Canada’s case, taxpayers are particularly vulnerable through the mortgage insurance provided by the Crown Corporation, the Canada Mortgage and Hous-ing Corporation (CMHC), which is fully guaranteed by the federal government. For all mortgages with a loan-to-value in excess of 80% from a federally regulated institution, the applicant must purchase insurance by law. According to the latest version of the Public Accounts of Canada, the size of CMHC’s insurance (insurance-in-force) has reached $482 billion (Government of Canada, 2010).

Additionally, a recent research paper by the Internation-al Monetary Fund (IMF) found that government participa-tion in the form of subsidies to first-time home buyers, tax deductibility of capital gains on housing, and government provision of mortgage guarantees or credit. exacerbated house price swings and amplified mortgage credit growth during the run-up to the global financial crisis, particularly in advanced economies (IMF, 2011). In other words, gov-ernment participation in housing finance actually contrib-utes to financial instability. In Canada, CMHC mortgage insurance functions as a form of mortgage guarantee.

The IMF described the results of an empirical study that analyzed the relationship between house prices, credit, and housing characteristics (2011). Housing characteristics included government participation, loan-to-value rations and types of mortgage products available. The analysis cov-ered 36 advanced and emerging market economies during two periods: the 2004–2007 global liquidity expansion, and the 2007–2009 financial crisis. The objective was to capture the feedback effects (cause and effect) between house price changes and financial stability during the financial crisis.

The analysis found that greater government participa-tion in housing finance did not provide a cushion against the crisis. On the contrary, countries with higher govern-

Government participation in housing finance:

The case for CMHC withdrawal keeps becoming strongerNeil MohiNdra

ment participation in housing finance experienced a deep-er house price downturn. Government participation am-plified the effect of higher house prices on mortgage credit growth before the crisis. The impact was greatest in ad-vanced economies. Stronger mortgage credit growth dur-ing the boom was associated with not only higher house price growth during that time, but also with a larger house price decline and higher levels of non-performing loans (a loan in or near default) during the subsequent bust.

Mohindra (2010) compared home ownership rates across Canada, the US, and Australia and found that Australia has maintained comparable ownership rates to Canada and the US despite the Australian federal gov-ernment exiting the mortgage insurance business and state governments withdrawing from mortgage-backed securities schemes. Mohindra also found that mortgage finance played a significant role in maintaining Austra-lia’s home ownership rate through 1994/95 and 2005/06, a period in which the number of people living in private dwellings increased by 13%. The IMF (2011) examined whether government participation in housing finance contributed to higher home ownership rates and its find-ings were consistent with Mohindra (2010). Despite the rational for government participation in housing finance often being to promote home ownership, the IMF found these two factors do not always correlate (see figure 1).

In April 2011, the US Treasury released a paper not-ing its intention to “pave the way for a robust private mortgage market by reducing government support for housing finance and winding down Fannie Mae and Freddie Mac on a responsible timeline” (US Treasury, 2011). The paper outlines a range of options the treasury was considering. Although each option retained some degree of future government participation in the mort-gage finance industry (i.e., government assistance such as insurance for narrowly targeted groups of low-in-come borrowers), all three options included a substan-tial degree of withdrawal by government and increased reliance of the private sector. IMF (2011) was broadly supportive of the direction of housing reform options cur-rently under consideration in the US, although noting some concerns with each option including moral hazard resulting from an ongoing limited government role. By maintaining some form of government participation, the IMF flagged this could create an expectation of government support in times of severe financial crisis.

An earlier consultation paper on housing reform included a question on what role the federal govern-ment should play in the housing finance system includ-ing whether the government should provide any explicit guarantees1 (US Treasury, 2010). In considering only options that reduce government exposure, the US ad-ministration expressly rejected options more consistent with the Canadian system with its explicit government guarantees through mortgage insurance.

The IMF paper reaffirms the need for the Canadian government to eliminate its support for the residential mortgage market, which made it through the financial crisis despite government guarantees through mortgage insurance. The US has shown that it has seen the light, al-beit with a reluctance to let go entirely. With hope, Canada will take action to eliminate its exposure to the mortgage finance market before a crisis rather than after one. Acting beforehand will not only save taxpayers a lot of money, but as shown by the recent IMF publication, will also lessen the magnitude of the crisis.

Note

1 Fannie Mae and Freddie Mac were long perceived to have an “implicit” guarantee form the US government. While there was no formal guarantee, there was a market expectation that these entities would be bailed out by the US government in the event of insolvency.

References

Government of Canada (2010). Public Accounts of Canada 2010. <http://www.tpsgc-pwgsc.gc.ca/recgen/pdf/49-eng.pdf>, as of May 20, 2011.

International Monetary Fund (2011). Housing Finance and Financial Stability – Back to Basics (April). <http://www.imf.org/external/pubs/ft/gfsr/2011/01/pdf/chap3.pdf>, as of May 6, 2011.

Mohindra, Neil (2010). Mortgage Finance Reform; Protecting Taxpayers from Liability. The Fraser Institute. <http://www.fraserinstitute.org/research-news/display.aspx?id=15934>, as of May 6, 2011.

US Treasury (2011). Reforming America’s Housing Finance Market; A Report to Congress (April). <http://www.trea-sury.gov/initiatives/Documents/Reforming%20Ameri-ca’s%20Housing%20Finance%20Market.pdf>, as of May 6, 2011.

US Treasury (2010). Obama Administration Seeks Public Input on Reform of the Housing Finance System. (April). <http://www.treasury.gov/press-center/press-releases/Pages/tg639.aspx>, as of May 9, 2011.


Singapore

Netherlands

United States

Russia Canada

Japan

France

Denmark

Australia

GermanyCzech Republic United

Kingdom

Austria

Chile

Slovakia

HungarySlovenia

PolandSpain

IrelandBelgium

Italy

Higher government participation

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0

Gov

ernm

ent p

artic

ipat

ion

(inde

x 0-

1)

40 50 60 70 80 90 100

Homeownership rate (%)

Figure 1: Homeownership rate and government participation in housing finance

Source: International Monetary Fund (2011); IMF staff estimates.


It is nearly impossible for an or-dinary Canadian to have a clear idea of how much tax s/he really

pays, which is why the Fraser Institute annually calculates Tax Freedom Day in order to provide a comprehensive and easily understood indicator of the overall tax burden faced by the aver-age Canadian family. This article sum-marizes our 2011 Tax Freedom Day report (Palacios and Veldhuis, 2011).

Tax Freedom Day

Tax Freedom Day is the day that the average Canadian family has earned enough money to pay the taxes im-posed on them by the three levels of the Canadian government: federal, provincial, and local. Taxes used to calculate Tax Freedom Day include income taxes, property taxes, sales taxes, profit taxes, health, social se-curity and employment taxes, im-port duties, license fees, taxes on the consumption of alcohol and tobacco, natural resource fees, fuel taxes, hos-pital taxes, and a host of other levies.

In 2011, Canadians started work-ing for themselves on June 6th (table 1). That is, Canadians worked until June 5th to pay the total tax bill imposed on them by all levels of government. From June 6th to the end of the year, taxpay-ers can keep all the income they earn.

Canadians can calculate their personal Tax Freedom Day using the Fraser Institute’s Personal Tax Free-dom Day Calculator at www.fraserin-stitute.org.

A later Tax Freedom Day

This year, Tax Freedom Day arrived two days later than in 2010, when it fell on June 4th.1 The latest Tax Free-dom Day in Canadian history was in 2000, when it occurred on June 24th, almost two months later than it did in 1961 (May 3rd), the earliest year for which the calculation has been made (Palacios and Veldhuis, 2011).

Tax Freedom Day declined slightly from 2000 to 2005, receding from June 24th to June 21st. From 2005 to 2009, Tax Freedom Day for the average Canadian family occurred earlier, moving from June 21st in 2005, to June 1st in 2009. There are many reasons for the relatively large change in Tax Freedom Day over this period. Prior to the 2008/09 recession, the federal government and many prov-inces reduced taxes.2 However, much of the decline in Tax Freedom Day in both 2008 and 2009 had nothing to do with either federal or provincial government tax reductions. Tax Freedom Day is a comparison of income and total taxes for average Canadian families.

When the economy slows and incomes either stagnate—or worse—decline (as was the case during the 2008/09 economic re-cession), the tax burden of those families tends to be reduced to a greater extent. This accelerated de-crease in the tax burden compared to income is a result of the progres-sive nature of the Canadian tax sys-tem. Progressivity means that as one earns more income, s/he pays proportionately more in taxes. The reverse is also true. It is this reverse phenomenon that stimulated some of the decline (improvement) in Tax Freedom Day in 2008 and 2009.

In addition, other cyclically related tax reductions help im-prove Tax Freedom Day during an economic downturn. For example, reductions in consumption by fami-lies decrease the amount of sales and other consumption taxes they pay.

In 2010 and 2011, the economy rebounded and Canadians saw Tax Freedom Day arrive later in both years. As explained above, when the economy recovers and incomes in-crease, a family’s tax burden tends to increase, but to a greater extent be-cause of our progressive tax system. Household consumption also in-creases, which results in an increase in the amount of sales and other con-sumption taxes that Canadian fami-

Milagros Palacios aNd Niels Veldhuis

Canadians celebrated Tax Freedom Day on June 6th


1981 1985 1995 2000re 2005re 2009re 2010re 2011pe

Newfoundland & Labrador 18 May 9 May 24 May 7 June 23 June 17 June 20 June 19 JunePrince Edward Island 6 May 7 June 22 May 1 June 8 June 24 May 25 May 27 MayNova Scotia 11 May 17 May 31 May 11 June 18 June 30 May 6 June 7 JuneNew Brunswick 6 May 2 June 1 June 5 June 7 June 26 May 29 May 31 MayQuebec 7 June 17 June 9 June 4 July 26 June 3 June 6 June 10 JuneOntario 29 May 26 May 8 June 14 June 15 June 1 June 3 June 4 JuneManitoba 17 May 5 May 14 June 20 June 21 June 29 May 31 May 1 JuneSaskatchewan 24 May 17 May 20 June 26 June 3 July 6 June 6 June 6 JuneAlberta 30 May 22 May 2 June 18 June 15 June 17 May 16 May 18 MayBritish Columbia 9 June 16 June 12 June 25 June 24 June 2 June 4 June 6 JuneCanada 30 May 6 June 11 June 24 June 21 June 1 June 4 June 6 June

Without Natural ResourcesNewfoundland & Labrador 17 May 8 May 23 May 6 June 15 June 26 May 24 May 24 MaySaskatchewan 15 May 9 May 13 June 15 June 21 June 30 May 27 May 27 MayAlberta 6 May 3 May 24 May 24 May 25 May 10 May 9 May 11 MayBritish Columbia 6 June 12 June 8 June 16 June 17 June 30 May 1 June 3 JuneCanada 27 May 4 June 9 June 19 June 17 June 30 May 2 June 4 June

Table 1: Tax Freedom Days*

re = revised estimate; pe = preliminary estimate.* based on total taxes as a percentage of cash income for families with two or more individuals. Cash income includes wages and salaries, self-employment income (farm and non-farm), interest, dividends, private and government pension payments, old age pension payments, and other transfers from governments (such as universal child care benefit).Source: The Fraser Institute’s Canadian Tax Simulator, 2011.

Tax Freedom Day Balanced budget Tax Freedom Day

Total increase (days) Federal Provincial

Newfoundland & Labrador 19 June 25 June 6 7 -1

Prince Edward Island 27 May 8 June 12 8 4

Nova Scotia 7 June 21 June 14 9 5

New Brunswick 31 May 16 June 16 9 7

Quebec 10 June 21 June 10 6 4

Ontario 4 June 26 June 22 10 12

Manitoba 1 June 14 June 13 9 4

Saskatchewan 6 June 12 June 6 7 -1

Alberta 18 May 2 June 15 9 6

British Columbia 6 June 18 June 12 10 2

Canada 6 June 22 June 16 9 7

Table 2: Tax Freedom Days including government deficits, 2011, preliminary estimates

Impact of federal and provincial government deficits on Tax Freedom Day

Note: numbers may not add due to rounding. Source: The Fraser Institute’s Canadian Tax Simulator, 2011; 2011 Provincial Budgets.


lies pay. Business profits also increase during a recovery, which then in-creases the profit taxes businesses pay.

Unfortunately, some provinces also increased taxes in 2011, which contrib-uted to the later Tax Freedom Day. For example, Quebec increased its provincial sales tax rate, its health tax (introduced in 2010), and gas and mining taxes; British Columbia increased its monthly Medical Services Plan premium (health tax); New Brunswick increased its fuel and tobacco tax; and both Manitoba and Prince Ed-ward Island increased their tobacco tax.3

Tax Freedom Day by province

While all Canadians face more or less the same federal tax bill, Tax Freedom Day for each province var-ies according to the extent of the pro-vincially levied tax burden (table 1). This year, the earliest provincial Tax Freedom Day fell on May 18th in Al-berta, while the latest date fell on June 19th in Newfoundland & Labrador.

Every province—save for New-foundland & Labrador and Saskatche-wan—saw its Tax Freedom Day move further in the year between 2010 and 2011, meaning that most citizens are working more for the government and less for themselves and their families this year than last (table 1).

Given that there is some debate as to whether natural resource royal-ties are actually a tax, we provide two sets of Tax Freedom Days for provinc-es with significant natural resources. If natural resource revenues are ex-cluded, Tax Freedom Day recedes by 26 days in Newfoundland & Labrador, 10 days in Saskatchewan, 7 days in Alberta, and 3 days in British Columbia (table 1).

Balanced budget Tax Freedom Day

Canadians may rightfully be think-ing about the economic and tax implications of the recent return to budget deficits. Indeed, almost

all Canadian federal and provincial governments (excluding Saskatch-ewan and Newfoundland & Labra-dor) are forecasting budget deficits for 2011. The federal government budgeted for a $29.6 billion deficit in 2011/12 while the provinces are cumulatively forecasting deficits amounting to $24.8 billion.4

Of course, today’s deficits must one day be paid for by taxes. Defi-cits should therefore be considered as deferred taxation. For this reason, we calculate a Balanced Budget Tax Freedom Day, the day on which av-erage Canadians would start work-ing for themselves if governments were obliged to cover current ex-penditures with current taxation and were not able to defer any of the tax burden by running a deficit.

Table 2 presents Balanced Bud-get Tax Freedom Days for Canada and its provinces. Balanced Budget Tax Freedom Day arrives on June 22nd, meaning the average Canadian family would have to work until June 21st to pay the tax bill if, instead of financing its expenditures by deficits, Canadian provincial gov-ernments had simply increased tax rates to balance their budgets. The Balanced Budget Tax Freedom Day arrives sixteen days later than Tax Freedom Day. Nine of the sixteen days are due to the federal deficit and the remainder to the provincial defi-cits. The latest Balanced Budget Tax Freedom Day will fall on June 26th in Ontario, over three weeks later than that province’s Tax Freedom Day.

Conclusion

The Canadian tax system is complex and there is no single number that can give us a complete idea of who pays how much; that said, Tax Free-dom Day is the most comprehensive and easily understood indicator of the overall tax bill of the average Canadian family. In 2011, Canadi-ans celebrated Tax Freedom Day on June 6th—two days later than in 2010.

Notes

1 As is the case every year, Tax Freedom Day calculations are based on forecasts of personal income, and on federal and provincial budget tax revenue. When fi-nal revenue numbers become available at the end of each fiscal year and personal income data are updated by Statistics Canada, we revise our Tax Freedom Day calculations for previous years.

2 For example, tax payers benefited from the reductions in the Goods and Services Tax (GST) rate from 7% to 6% in 2006 and to 5% in 2008. In addition, prov-inces such as British Columbia enacted personal income tax relief; Saskatch-ewan reduced its corporate income and capital taxes and reduced its provincial sales tax; and Manitoba cut its middle personal income tax rate and small and large corporate income tax rate (Palacios and Veldhuis, 2011).

3 A complete delineation of tax changes is available in the 2011 provincial budgets.

4 The cumulative deficit figure only in-cludes those provinces with forecasted deficits for 2011/12. Saskatchewan is forecasting a surplus of $115 million. Meanwhile, Newfoundland and Lab-rador forecasted a small surplus of $59 million (Palacios and Veldhuis, 2011).

References

Palacios, Milagros, and Niels Veldhuis (2010). Canadians Celebrate Tax Freedom Day on June 5, 2010. Fraser Alert (June). Fraser Institute.

Palacios, Milagros, and Niels Veldhuis (2011). Canadians Celebrate Tax Freedom Day on June 6, 2011. Fra-ser Alert (June). Fraser Institute.


Mark roVere aNd Bacchus Barua

In recent years, provincial governments have attempted to harness health expenditures by regulating generic drug prices1 covered by public drug programs. How-

ever, if the provinces with aged-based eligibility crite-ria for public drugs plans replaced their programs with means-tested eligibility for catastrophic coverage, signifi-cant savings could be achieved.

Although, on average, seniors take more medica-tion than younger individuals (CIHI, 2010), it is incor-rect to assume that all seniors need subsidized drug coverage. Instead, a better use of public funds would be to subsidize only those who require financial assistance to pay for their medications. Ontario, in particular, is a province that could take advantage of the possible sav-ings generated by this policy reform.

Ontario’s public drug programs

The Government of Ontario operates Canada’s largest taxpayer-funded drug plan, covering approximately 2.8 million residents at an annual cost of over $4 billion. The program accounts for 45% of Ontario’s total drug expenditures and includes four components: the On-tario Drug Benefit [ODB] program, the Trillium Drug Program, the Special Drugs Program, and the New Drug Funding Program for Cancer Care. The majority of Ontario’s public drug funding is allocated to the ODB and the Trillium Program, while the other two programs provide funding assistance on a case-by-case basis for

patients with special medical needs (Ministry of Health and Long-Term Care, 2011a).

Although Ontario’s public drug plans assist individ-uals and families with low incomes and special medical needs, all of the province’s 1.8 million (2008) residents over the age of 65 are eligible for the ODB regardless of their income (Ministry of Finance, Ontario, 2010; Ministry of Health and Long-Term Care, 2011a). While a small copayment and annual deductible may be re-quired, patient cost-sharing is not linked to the price of the prescription or the recipient’s income (see table 1).

In contrast, the Trillium Drug program assists Ontario residents who spend a significant amount of their after-tax income on prescription medicines. The program provides access to certain prescription drugs (listed on the provincial formulary) for households that spend more than 4% of their household net income on drug costs. As seen in table 1, unlike the ODB, recipi-ents of the Trillium program are required to pay an an-nual deductible based on household net income (not ex-ceeding 4% of after-tax income), and is adjusted for the number of family members per household. Importantly, the Trillium Drug Program is not intended to replace private insurance. It is meant for Ontario residents who do not have private insurance coverage and are not eli-gible for the province’s other publicly funded programs. It also serves residents who have private insurance cov-erage that only partially covers drug costs (where drug costs exceed 4% of household net income) (Ministry of Health and Long-Term Care, 2011c). In other words,

Ontario should replace age-based drug subsidies

Net IncomeSingle seniors (65+)

< $16,018

> $16,018

Deductible

-----

$100

Co-payment

$2

$6.11

Net IncomeSingle Persons

$8,000 - $8,500

$16,000 - $16,500

$32,000 - $32,500

Deductible

$370

$461

$1,051

Co-payment

$2

$2

$2

Table 1: Ontario Drug Benefit Program and Trillium Drug Program: Deductible and co-payment by net income, 65 years and older

Ontario Drug Benefit Program Trillium Drug Program

Source: Ministry of Health and long-term care, 2011c; 2011e.

......


unlike the ODB where eligibility is not linked to income, the Trillium Drug Program is intended to be a safety net for Ontario residents with catastrophic drug costs that are not covered (fully or partially) by private insurance.

Do all seniors need a subsidy?

Not all seniors require financial assistance to pay for their prescription drugs. Table 2 displays the total taxable in-come returns (2008 tax year) for Ontario residents 65 years and older. As shown, in 2008, 84.2% of Ontario’s seniors had a gross income of $20,000 or more and 27.6% of se-niors earned more than $50,000 (Canada Revenue Agency, 2010). Although it is often assumed that seniors are low-in-come earners, the data indicate that it is not always the case.

More importantly, the data show that in general, se-niors typically do not spend a significant amount of their net income on medication. As table 3 indicates, in 2008, the median-after tax income of families 65 years and older in Ontario was $51,600 (Statistics Canada, 2010). At the same time, seniors spent approximately $1,8172 on prescription drugs (Morgan et al., 2008).

Notably, this is only slightly above the $1,699 “cata-strophic” drug cost threshold proposed by the 2002 Ro-manow Commission ($1,500 in 2002 adjusted for infla-tion),3 and close to the 3% catastrophic drug cost threshold recommended by the Kirby Report4 (Romanow, 2002; Kir-by, 2002).5 Moreover, the average annual drug expenditure for seniors ($1,817) accounts for only 3.5% of the median after-tax income of elderly families in Ontario ($51,600), which is still below the catastrophic threshold of 4% de-fined by the Trillium Drug Program. Albeit, this represents 5.5% and 7.6% of their net incomes for unattached males and females respectively (table 3).

Income Class Males Females All seniors Total distribution among income classes

Under $10,000 $730 $3,890 $4,620 0.4%

$10,000-$15,000 $7,360 $17,660 $25,020 2.1%

$15,000-$20,000 $49,160 $108,350 $157,510 13.3%

$20,000-$25,000 $51,780 $80,550 $132,330 11.2%

$25,000-$30,000 $54,660 $60,750 $115,410 9.8%

$30,000-$35,000 $67,080 $72,460 $139,540 11.8%

$35,000-$40,000 $56,500 $66,000 $122,500 10.4%

$40,000-$45,000 $46,890 $41,540 $88,430 7.5%

$45,000-$50,000 $39,910 $30,890 $70,800 6.0%

$50,000-$100,000 $153,200 $103,420 $256,620 21.7%

$100,000 and over $46,180 $24,040 $70,220 5.9%

Table 2: Total taxable income returns for Ontario residents 65 years and older, by income class and sex, 2008 tax year

Source: Canada Revenue Agency, 2010; calculations by authors.


Means-testing and catastrophic threshold

It is clear that although some seniors do require govern-ment assistance because their drug costs are very high relative to their net income, taxpayers should not be re-sponsible for providing comprehensive drug coverage for everyone over the age of 65. In contrast, if seniors re-ceived public funding for drug coverage based on their household income, with an annual deductible based on a pre-determined “catastrophic” drug cost threshold,6 the Ontario government could save taxpayers a significant amount of money while still providing financial support to seniors who require it. Under this scenario, the ma-jority of seniors could purchase private drug insurance or pay for drug costs out-of-pocket, and subsequently apply for public coverage if the cost of their medication becomes “catastrophic.”

Savings

A basic estimate of the potential savings Ontario could experience by moving away from aged-based eligibility for drug coverage can be made based on the experience of British Columbia. In 2003, BC replaced its aged-based public drug program with Fair PharmaCare, an income-based plan. The program provides financial assistance to any BC resident who has catastrophic prescription drug costs relative to his or her net income. In addition, it provides partial assistance for residents incurring costs below that level but above an income-based deductible7

(Ministry of Health, 2011). A 2006 study (Morgan et al.) shows that substituting the province’s age-based pro-gram with Fair PharmaCare likely resulted in a 16.9% decrease in public spending. Further, the study conclud-ed that the change did not reduce access to prescription drugs for seniors or for residents with different income levels.

Assuming that similar savings could be generated for Ontario if a comparable program were implement-ed, the Ontario government could save a minimum of approximately $710 million (16.9% of Ontario’s $4.2 billion public drug program) (Ministry of Health and Long-Term Care, 2011d; authors’ calculations). In fact, if the catastrophic threshold was placed at 4% in ac-cordance with the Trillium program, the savings would likely be even higher.

Conclusion

It is unnecessary for taxpayers to subsidize the cost of drugs for those who can afford it, and the data show that very few seniors actually require financial assistance to pay for their medications. Notably, as more baby-boom-ers become seniors, more money will be required to fund drug coverage for this growing population. The optimal policy is to provide means-tested subsidies to those with low incomes, regardless of age, to purchase catastrophic drug insurance in a private, competitive, insurance mar-ket, where recipients would have the choice of selecting the drug plan that meets their individual medical needs and financial abilities (Skinner, 2005). However, at the

Sources: Statistics Canada, 2010; Morgan et al., 2010; Romanow, 2002; calculations by authors.

Median after-tax income

2007 average Rx

spending for seniors,

adjusted for inflation

% of median

after-tax income

on Rx spending

Romanow's catastrophic

threshold ($2002)


threshold ($1,500 in 2002)

adjusted for inflation ($2008)


threshold as a % of median

after-tax income

Elderly families (65 and older)

$51,600 $1,817 3.5% $1,500 $1,699.13 3.3%

Unattached Individuals

Elderly males $33,200 $1,817 5.5% $1,500 $1,699.13 5.1%

Elderly females $24,000 $1,817 7.6% $1,500 $1,699.13 7.1%

Table 3: Median after-tax income and average prescription drug spending for Ontario seniors (65 and older), 2008


very least, Ontario, which spends over $4 billion annu-ally on public drug expenditures, should take note of BC’s experience and move away from automatic public drug coverage based on age alone.

Notes

1 Following Ontario’s lead, a number of provincial govern-ments have regulated the price of generic drugs as a percentage of their brand-name equivalents.

2 Averaged across Canada with 2007 data adjusted to 2008 dollars for inflation (Morgan et al., 2008).

3 The 2002 Romanow report proposed a federal catastrophic drug transfer to the provinces for drug costs that exceeded $1,500 per person per year. Although the federal transfer was never implemented, the report found that annual personal drug expenditures above $1,500 should be considered “cata-strophic” (Romanow, 2002). Provincial public drug programs continue to be provincially funded.

4 Senator Kirby recommended that public drug coverage be provided to Canadians that spend over 3% of their net annual income on prescription drugs (catastrophic coverage) (Kirby, 2002).

5 The Romanow (2002) and Kirby (2002) Reports provide the most commonly cited recommendations for catastrophic drug costs threshold in Canada.

6 As defined (for example) by either the Kirby Re-port (3%) or the Trillium Drug Program (4%). 7 Lower deductibles and catastrophic thresholds are used for families that include an individual born in 1939 or earlier.

References

Canadian Institute for Health Information (2010). Drug Use Among Seniors on Public Drug Programs in Canada, 2002 to 2008. Canadian Institute for Health Information.

Canada Revenue Agency (2010). Final Basic Table 6: All Re-turns by Age, Sex, Total Income Class, and Major source of Income, Ontario. Government of Canada. <http://www.cra-arc.gc.ca/gncy/stts/gb08/pst/fnl/html/t06on-eng.html>, as of May 31, 2011.

Kirby, Michael J.L. (2002). The Health of Canadians – The Fed-eral Role Volume Five: Principles and Recommendations for Reform – Part 1. The Standing Senate Committee on Social Affairs, Science and Technology. <http://www.parl.gc.ca/Content/SEN/Committee/372/soci/rep/repoct02vol-6part3-e.htm#CHAPTER%20SEVEN>, as of May 31, 2011.

Ministry of Finance, Ontario (2010). Ontario Population by Five-Year Age Group, 2009–2036. Government of Ontario.

Ministry of Health, British Columbia (2011). Fair Pharma-Care. Government of British Columbia.<http://www.health.gov.bc.ca/pharmacare/plani/planiindex.html#6>, as of May 31, 2011.

Ministry of Health and Long-Term Care (2011a). Ontario Drug Benefit Program. Publicly Funded Drug Programs. Government of Ontario. <http://www.health.gov.on.ca/en/public/programs/drugs/funded_drug/>, as of May 31, 2011.

Ministry of Health and Long-Term Care (2011b). Ontario Drug Benefit: The Program. Government of Ontario. <http://www.health.gov.on.ca/english/public/pub/drugs/odb.html>, as of May 31, 2011.

Ministry of Health and Long-Term Care (2011c). A Guide to Understanding the Trillium Drug Program. Trillium Drug Program. Government of Ontario.

Ministry of Health and Long-Term Care (2011d). 2007/2008 Interim Report Card for the Ontario Drug Benefit Program. Government of Ontario. <http://www.health.gov.on.ca/en/public/publications/ministry_reports/odb_report-08docs/odb_rep_07_08.pdf>, as of May 31, 2011.

Ministry of Health and Long-Term Care (2011e). Ontario Drug Benefit Program: Questions and Answers. How much do I pay? <http://www.health.gov.on.ca/en/public/programs/drugs/drugsfaq_dt.aspx#Q2>, as of June 17, 2011.

Morgan, Steve, Colette Raymond, Dawn Mooney, and Daniel Martin (2008). The Canadian Rx Atlas, 2nd edition. UBC Centre for Health Services and Policy Research. University of British Columbia.

Morgan, Steve, Robert G. Evans, Gillian E. Hanley, Patricia A. Caetano, and Charlyn Black (2006). Income-Based Drug Coverage in British Columbia: Lessons for BC and the Rest of Canada. Healthcare Policy. (November) 2(2): 115–127. Longwoods Publishing.

Romanow, Roy (2002). Building on Values: The Future of Health Care in Canada – Final Report. Commission on the Future of Health Care in Canada.

Skinner, Brett J (2005). Universal Drug Benefits for Seniors: Unnecessary, Unsustainable, and Unfair. Fraser Institute.

Statistics Canada (2010). Income in Canada 2008. Statistics Canada.


Mark Milke

Between 1985/86 and 1993/94, the province of Alberta ran nine consecutive deficits, the conse-quences of which were long lasting (Department

of Finance, 2000 and 2010). First, Canada’s wealthiest province—with significant net assets in the mid-1980s—saw its financial position deteriorate into net debt by the end of that deficit era. Second, the costs of the continual

“red ink” extended beyond even the period of return of the surplus years. That’s because, obviously, debts last lon-

ger than annual deficits and create a significant, ongoing diversion of tax dollars from other purposes in order to finance interest costs; the cost of the red ink also has a long “shelf life” as newer taxes are also used to pay down old debt. Third, to finance the growing provincial debt, existing taxes were raised and new taxes imposed, which increased barriers to investment, income growth, and job creation in Alberta. Simultaneously, the provincial gov-ernment ceased transfers entirely to the Alberta Heritage

Alberta heads back to the 1980s


Savings and Trust Fund (AHSTF)—a fund originally set up to preserve some of the province’s resource wealth for future generations—in an attempt to keep more revenue.

History is not guaranteed to repeat, but recent signs and actions contradict present optimistic expectations about the province’s finances. After all, in 1987, the province’s net financial position (i.e., assets minus lia-bilities) was still healthy; it was the trend—a continuous deterioration in Alberta’s finances—that was worrying:

The history of Alberta’s fiscal ground has been well-covered by others.1 From this research, it is already clear that fiscal history is repeating itself, and it appears that Alberta’s rhetorical history is also repeating itself. Here are some similarities between the two deficit eras:

Parallel #1: “Alberta is not in debt”

Both in the 1980s and recently, the political rhetoric initially emphasized that Alberta could “afford” deficits given its overall net asset position, i.e., the value of Al-berta’s assets was higher than the value of its liabilities.

In 1985, Treasurer2 Lou Hyndman noted the net asset posi-tion of the province: “There are few governments in the world that can match the financial strength of the province of Alberta,” said Hyndman in his March 1985 budget speech (Alberta, 1985: 12).

Similarly, in early April 2009, Premier Ed Stelmach re-jected a University of Calgary report that warned the pro-vincial government was facing a 1980s-style quagmire on public finances; Stelmach called it “nonsense.” He stated:

“Look at our balance sheet. We’re the only jurisdiction in North America that has cash in the bank-liquid” while refer-ring to the province’s net asset position (Fekete, 2009: A10).

Parallel #2: Promises of a balanced budget in four years

In his March 1988 budget speech, Treasurer Dick Johnston proclaimed that a “solid recovery” had begun the year previous with oil prices rising (Alberta, 1988: 5). The treasurer forecasted a deficit for the upcoming year but insisted a balanced budget would occur by 1990/91 (Alberta, 1988: 10; 30)—the original four-year target assumed by Budget 1987 (Alberta, 1987: 13).

In 2009, Finance Minister Iris Evans predicted a balanced budget by 2012/13, and thus four years of deficits in the interim (Alberta, 2009: 3). Similarly, in February 2010, the newest Alberta finance minister, Ted Morton, repeated the previous year’s pledge from Evans on a surplus after four years of deficits (Alberta, 2010).

Parallel #3: The four-year budget target is missed

By June 1989, the Alberta government admitted its earlier forecasts of a balanced budget would be delayed one year. Treasurer Dick Johnston informed a newspaper reporter that the four-year target would be missed and insisted the deficit would be eliminated by 1991/92, a year later than projected (Geddes, 1989: A10).

Similarly, in the newest deficit era, in a late-2010 interview, Premier Stelmach announced a four-year balanced budget deadline would be pushed off further into the future (Fekete, 2010: A1). In his 2011 budget speech, the newest Finance Minister, Lloyd Snelgrove, also confirmed the previous four-year balanced budget target would not be met (Alberta, 2011a: 12).

Parallel #4: (Another) false start on balanced books?

In 1990 and 1991, a fiscal “head-fake” rise in energy prices due to the Gulf War led the politicians of the day to think a balanced budget might be accomplished within the original four-year period. At budget time in 1991, where a $33-million surplus was forecast for the next budget year, the premier said that “Albertans shouldn’t be surprised if a projected budget surplus of $33 million ends up being a lot larger” (Laghi, 1991: A1). The premier turned out to be overly optimistic: the projected surplus turned into a $2.6 billion deficit (Alberta, 2001: 58).

More recently, in May 2011, in a speech to the Alberta Weekly Newspaper Association, Alberta’s current premier, Ed Stelmach, hinted the off-again four-year target for balanced books might be “on” again, citing higher oil and gas prices (Henton, 2011: A4).

The province tried to balance the books with tax increases and ended transfers to the Heritage Fund

In the 1980s, attempts were certainly made to balance the books before expenditure cuts were considered. The provincial government reduced and then entirely stopped resource revenue transfers to the Alberta Heritage Savings Trust Fund (AHSTF or “Heritage Fund”)3. The province also re-directed investment income earned on the fund to general revenues (Alberta, 1986: 11; Alberta, 1987: 14).

The second significant attempt to eliminate the deficit came in the form of tax increases. “We will increase taxes substantially at the outset of this deficit reduction

Alberta heads back to the 1980s


plan,” said Treasurer Dick Johnston in his March 1987 budget address (Alberta, 1987: 13). In total, the increased and new taxes were expected to bring in extra revenue of $1 billion in 1987/88 (Alberta, 1987: 20–22), or about 12.5% of all own-source revenues4 the province had accrued in the year previous (Alberta, 2001: 58). However, the province still incurred deficits until 1994/95.

Deficits were only banished with attention to the over-spending

The recent political rhetoric in Alberta mimics the mid-1980s and early 1990s. In both eras, the fact that program expenditures outpaced revenues in most years made deficits inevitable once energy prices declined. For example, between 1980/81 and 1985/86—before any significant (later) decline in revenues—revenues rose by 49%, but program spending increased by 85% (Department of Finance, 2000). In the newer deficit era, there was an actual 4.4% decrease in revenue while program spending rose by 43.4% between 2005/06 and 2010/11 (Alberta, 2011b).

In Alberta’s previous deficit era, chronic deficits were only addressed once rhetorical change took place and real per capita program spending was cut significantly.

In the 1980s, real per capita program spending hit a high of $11,496 in 1985/86 and took significant reductions to bring the books into balance. Real per capita program spending declined to a low of $6,498 in 1996/97. Since then, the trend-line has been mostly upward. Real per capita program spending hit $10,237 in 2008/09, dipped slightly in the next year, and rose again to $10,303 in 2010/11 (Department of Finance 2000 and 2011; Alberta 2011b; Statistics Canada 2011; calculations by Milagros Palacios).

Needed: A reversal in rhetoric and Alberta’s actions

Here is where the parallels between the two eras diverge: By 1993, the provincial government decided a balanced budget would not occur unless a determined effort was made to rein in program expenditures. In 1993, then Finance Minister Jim Dinning said that in retrospect, while 1986 was the year it became apparent that Alber-ta had a spending problem, spending continued even though the bottom had fallen out of oil and gas revenues.

“It was at a time when we believed a problem could be solved by spending more money on it. We’ve learned, painfully, that that thinking was never very accurate,” said Dinning (Alberts and Pommer 1993, A1). That was then. Now, in the newer deficit era, neither the rhetoric nor the actions have changed to deal with Alberta’s new-est deficits.

Sources: Canada, Department of Finance 2000, 2010; Alberta 2011b; Statistics Canada, CANSIM Table 326-0021 and 051-0005; calculations by Milagros Palacios.

Figure 1: Alberta per capita program spending (adjusted by inflation),

1981/82 – 2010/11

In 2010 $

9,285

10,944

10,259

10,135

11,496

10,577

9,648

9,623

9,597

9,462

8,968

9,350

8,545

7,412

6,731

6,498

6,776

6,805

7,434

7,765

8,329

7,894

7,984

8,528

9,135

9,352

9,839

10,237

9,995

10,303

0 2,000 4,000 6,000 8,000 10,000 12,000 14,000

1981-82

1982-83

1983-84

1984-85

1985-86

1986-87

1987-88

1988-89

1989-90

1990-91

1991-92

1992-93

1993-94

1994-95

1995-96

1996-97

1997-98

1998-99

1999-00

2000-01

2001-02

2002-03

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

2009-10

2010-11


Alberta (2011c). Historical Timeline. <http://www.finance.al-berta.ca/business/ahstf/history.html>, as of June 20, 2011.

Alberts, Sheldon, and Dave Pommer (1993, December 11). Deficit Woes Began in ’79. Calgary Herald: A1.

Boothe, Paul (1995). The Growth of Government Spending in Alberta. Canadian Tax Foundation.

Bruce, C.J., Ronald D. Kneebone, and K.J. Mckenzie (1997). A Government Reinvented: A Study of Alberta’s Deficit Elimi-nation Program. Oxford University Press.

Department of Finance (2000). Fiscal Reference Tables (Sep-tember), Table 26. <http://www.fin.gc.ca/afr-rfa/2000/frt00e.pdf>, as of May 24, 2011.

Department of Finance (2010). Fiscal reference Tables (Octo-ber), Table 25. <http://www.fin.gc.ca/frt-trf/2010/frt-trf-10-eng.pdf>, as of May 24, 2011.

Emery, J.C. Herbert, and Ronald D. Kneebone (2009). Will It Be Déjà Vu All Over Again? University of Calgary School of Public Policy. <http://policyschool.ucalgary.ca/files/publicpolicy/SPP%20Briefing%20Paper%20-%20Knee-bone%20&%20Emery%20FINAL%20%28Apr%2009%29.pdf>, as of May 24, 2011.

Fekete, Jason (2009, April 3). ‘80s-era Crisis Feared in Alberta; Pre-mier Rejects Warning in U of C Report. Calgary Herald: A1.

Fekete, Jason (2010, December 21). Premier Warns of Cuts to Come; Year-End Interview; Tories Back Off Vow To Bal-ance Budget By 2013. Calgary Herald: A.1

Geddes, Ashley (1989, June 9). Deficit-Trimming Blueprint A Victim Of Circumstances. Calgary Herald: A10.

Henton, Darcy (2011, May 7). “Alberta Could Be Back In The Black Next Year; Strong Energy Prices May Help Cut Defi-cit.” Calgary Herald, A4.

Kneebone, Ronald D. (2002). Recent and Not So Recent Trends in Provincial Government Spending in Alberta: Discussion paper. University of Calgary Department of Economics.

Kneebone, Ronald D. (2006). The Government of Alberta’s Fiscal Future: Possibilities and Pitfalls. University of Calgary In-stitute for Sustainable Energy, Environment, and Economy.

Laghi, Brian (1991, April 5). “Getty Challenges Critics; ̀ It Still Isn’t All Roses,’ Premier Warns; BUDGET ‘91.” Edmonton Journal: A1.

Statistics Canada (2011), Statistics Canada, CANSIM Table 326-0021. Consumer Price Index.

Notes

1 In particular, see Bruce et al., 1997; Booth , 1995; Kneebone, 2002; Kneebone, 2006; Alberta, 2007; Emery and Kneebone, 2009.

2 The official title of finance ministers in Alberta before 1993 was treasurer.

3 Previously, beginning with the fund’s creation in 1976/77, the province transferred 30% of all resource revenues annually into the fund, then gradually reduced that percentage, ending such transfers entirely in 1987 (Alberta, 2011c).

4 Own-source revenue is revenue raised by the province and not transferred from the federal government.

References

Alberta (1985, March 23). Budget Address 1985. Government of Alberta.

Alberta (1986, April 10). Budget Address 1986. Government of Alberta.



Alberta (2001). Budget 2001. Fiscal Plan 2001–2004 (Historical Consolidated Fiscal Summary, 1984–1985 to 2003–2004: 58). Government of Alberta. <http://www.finance.alberta.ca/publications/budget/budget2001/fiscal.pdf>, as of De-cember 3, 2010.

Alberta (2007). Preserving Prosperity: Challenging Alberta to Save. Government of Alberta. Alberta Financial Invest-ment and Planning Advisory Commission: Report and Recommendations. <http://www.finance.alberta.ca/fipac/fipac_final_report.pdf>, as of January 19, 2011.

Alberta (2009). Budget 2009. Budget Speech. Government of Alberta. <http://www.finance.alberta.ca/publications/budget/budget2009/speech.pdf>, as of January 17, 2011.

Alberta (2010, February 9). Budget 2010. News Release. <http://alberta.ca/acn/201002/27800B4A406EB-A356-7E61-4302D1F5162E55A2.html>, as of December 6, 2010.

Alberta (2011a). Budget 2011. Fiscal Plan Tables. Government of Alberta. <http://www.finance.alberta.ca/publications/budget/budget2011/fiscal-plan-tables.pdf>, as of February 28, 2011.

Alberta (2011b). Budget 2011. Speech. Government of Alberta. <http://www.finance.alberta.ca/publications/budget/bud-get2011/speech.pdf>, as of May 28, 2011.


Nadeem esmail

Taxing pop and butter won’t necessarily make Canadians skinny


Recently, the BC Medical Association -rec-ommended that government tax sugar-sweetened beverages, the Canadian Medi-cal Association recommended Parliament place higher taxes on “junk food,” and a

number of organizations recommended to the stand-ing committee on health in Ottawa that certain types of food should be taxed. Internationally, Denmark intro-duced a levy on a range of fatty dairy products on July 1st, 2011, while Norway and Sweden are both consider-ing their own selective food taxes.

This idea—to tax food that some nutritionists and researchers don’t want individuals to consume—is in-creasingly accepted. Proponents of the so-called “fat tax” not only offer it as a way to improve diets, but also treat it as an assumed key component of a regulatory strategy to shrink the waistlines of Canadians. However, the truth is that a “fat tax” or “junk food tax” is merely a blunt instrument that doesn’t directly deal with the problem (the number of overweight and obese Canadi-ans) about which so many politicians and pundits are concerned.

Taxing less healthful food options, such as fatty dairy products or sugar-sweetened beverages is often compared to the taxation of cigarettes: a public health measure intended to improve a population’s health and wellbeing. This misleading comparison ignores a simple reality: consuming cigarettes is directly linked to smok-ing-related illnesses. The same is not true of less health-ful or fattier food options. They not only have some nu-tritional value, but are also not directly linked to excess weight.

Fundamentally, for most people, being overweight or obese is the result of an excess of caloric intake over caloric output. The consumption of less healthful and/or fattier foods when balanced with other foods and exer-cise will not lead to a person being overweight or obese, nor will it necessarily lead to poorer health. This absence of a direct connection reveals another serious problem with the idea of a “fat tax”: everyone has to pay it regard-less of their girth.

Consider the case of a Canadian who runs three times a week, plays sports from time to time, eats a well-balanced diet, and is in excellent physical condi-tion. If she desires a chocolate bar every day with her lunch, wants to cook her meals with butter, or likes to relax with a pop and watch a movie on the weekend, why should she pay more to do so?

Notably, in 2010, 52.3% of Canadians aged 18 and older, and 20.0% of Canadian youth (aged 12 to 17) re-ported themselves to be overweight or obese (Statistics Canada, 2011a and 2011b). In other words, flip those statistics over, and a sizable portion of the adult popula-

tion and the majority of the youth population are neither overweight nor obese by body mass index (the common metric of overweight and obesity) standards.

A “fat tax” not only fails to distinguish between overweight/obese Canadians and those who are not, but it is also a regressive form of taxation. A number of studies have found that diets of less healthy food options are less expensive than diets of healthier food options (Drenowski and Darmon, 2005; Drenowski et al., 2004; BCPHO, 2006; and CIHI, 2006).1 Further, lower socio-economic classes are typically more dependent on fast foods for their nutrition (Eisenberg et al., 2011). Both suggest that a tax on less healthful/fattier food options will have a disproportionate effect on lower-income Ca-nadians.

“Fat taxes” are also not guaranteed to reduce overall caloric intake, as some hope. Importantly, fast-food con-sumption (a likely target for a “fat tax”) may be relatively unresponsive to price changes because individuals may simply switch to other non-taxed, but still energy-dense foods2 (Eisenberg et al., 2011). Then there is the issue of defining which foods should be taxed and the difficulties therein (Eisenberg et al., 2011; Leicester and Windmei-jer, 2004). Targeting only one food group, such as sugar-sweetened beverages, does not necessarily resolve these issues or those outlined above; such targeting entirely ignores the complex and manifold causes of obesity.3

There is, of course, little debate about the fact that obesity does result in costs including negative health consequences, reduced life expectancies, negative effects on mental and emotional wellbeing, lost productivity, restricted activity, and poorer educational performance and skill attainment (Raine, 2004; Olshansky et al., 2005; Ding et al., 2006; BCPHO, 2006; and Cawley and Spiess, 2008).4 However, what is important for public policy is the distribution of those costs (or, who actually bears the burden of them). Upon closer examination, it seems that the majority of the costs listed above are borne di-rectly by the obese individual in terms of lower income, reduced enjoyment of life, and a potentially shorter life span. The only area where the individual does not bear these costs directly is the increased burden on Canada’s tax financed health system. These costs transpire be-cause the obese have an increased likelihood of diabetes, stroke, and other illnesses. Notably, many of the debates and discussions about policies to combat obesity in Canada begin with the health costs imposed on society through Medicare—costs then used to justify govern-ment intervention.

Thus, if there is an area of the obesity epidemic where governments have a legitimate role to intervene, it is to resolve the costs imposed by the obese on all taxpay-ers by reducing the cross-subsidization from non-obese

Regulation Review


Canadians to obese Canadians. Since obesity is in many cases controllable, and since the public burden of obesity is borne almost entirely through the Medicare program, it makes most sense to scale the Medicare premiums of obese individuals by the publicly borne medical costs of being obese5. Of course, appropriate reductions in the charge for low-income families (to a non-zero level) and for those who are less able to control their weight because of an un-derlying medical condition should be a part of this plan.

Such a scaled health premium not only gives indi-viduals and parents the incentive to lose their own or their children’s extra pounds, but is also sensitive to the existence of controllable obesity. Unlike a “fat tax” to which governments will likely become addicted, the premium would abate entirely with the elimination of controllable obesity. Equally importantly, it allows peo-ple to choose for themselves whether they wish to lose weight through a better diet, through more exercise, or not at all—a choice individuals should be free to make as long as they do not impose costs on others by doing so.

Most importantly, however, a scaled health pre-mium imposes the cost of controllable obesity on those responsible for it. It also does not negatively affect those who choose a healthier lifestyle (and in fact offers them a benefit for doing so), but who on occasion do snack on the occasional chocolate bar or fast-food hamburger.

“Fat taxes” are simply too blunt a policy tool to deal with the rising prevalence of overweight/obesity and poor diet. Targeted solutions that require the obese to take responsibility for the health costs created by their lifestyle choices are a far smarter solution.

Notes

1 This has been found to be true both in terms of dietary energy per dollar and in terms of absolute diet costs per day.

2 Foods that have a high caloric count per unit of mass.

3 These include reductions in the rate of smoking (Rashad, 2006; Rashad et al., 2005; Chou et al., 2002; Ostbye et al., 1995; Le Petit and Berthelot, 2006), increased labour-force partici-pation by women (Rashad and Grossman, 2004), increases in the availability of labour-saving devices, and increased sed-entary time/reductions in activity, among many others.

4 There is, however. some debate and discussion about the number of people adversely affected as well as the magnitude of these costs.

5 This solution applies to the current government-run health in-surance scheme. Were Canada to move to a competitive private insurance model of universal health insurance, insurance com-

Individuals should be free to make their own choices


insurance model of universal health insurance, insurance com-panies should be freed to adjust insurance premiums on the basis of controllable individual health risks such as overweight/obesity.

References

British Columbia Provincial Health Officer [BCPHO] (2006). Food Health and Well-Being in British Columbia. Provin-cial Health Officer’s Annual Report 2005. British Columbia Ministry of Health.

Canadian Institute for Health Information [CIHI] (2006). Improving the Health of Canadians: Promoting Healthy Weights. <www.cihi.ca>, as of May 30, 2011.

Cawley, John, and C. Katharina Spiess (2008). Obesity and Skill Attainment in Early Childhood. NBER Working Paper Se-ries, no. 13997.

Chou, Shin-Yi, Michael Grossman, and Henry Saffer (2002). An Economic Analysis of Adult Obesity: Results From the Behavioral Risk Factor Surveillance System. NBER Work-ing Paper Series, no. 9247.

Ding, Weili, Steven F. Lehrer, J. Niels Rosenquist, and Janet Audrain-McGovern (2006). The Impact of Poor Health on Education: New Evidence Using Genetic Markers. NBER Working Paper Series, no. 12304.

Drewnowski, Adam, and Nicole Darmon (2005). Symposium: Modifying the Food Environment: Energy, Density, Food Costs, and Portion Size. Food Choices and Diet Costs: an Economic Analysis. The Journal of Nutrition 135: 905–909.

Drewnowski, Adam, Nicole Darmon, and André Briend (2004). “Replacing Fats and Sweets with Vegetables and Fruits—A Question of Cost.” American Journal of Public Health 94: 1555–1559.

Eisenberg, Mark J., Renée Atallah, Sonia M. Grandi, Sarah B. Windle, and Elliot M. Berry (2011, May 2). Legislative Approaches to Tackling the Obesity Epidemic. Canadian Medical Association Journal.

Le Petit, Christel, and Jean-Marie Berthelot (2006). Obesity—A Growing Issue. Health Reports 17(3). Catalogue No. 82-003-XIE. Ottawa: Statistics Canada.

Leicester, Andrew, and Frank Windmeijer (2004). The ‘Fat Tax’: Economic Incentives to Reduce Obesity. Briefing Note, No. 49. The Institute for Fiscal Studies.

Olshansky, S. Jay, D.J. Passaro, R.C. Hershow, J. Layden, B.A. Carnes, L. Hayflick, R.M. Butler, D.B. Allison, and D.S. Ludwig (2005). A Potential Decline in Life Expectancy in the United States in the 21st Century. New England Journal of Medicine 352(11): 1138–1145.

Ostbye, T., D. J. Pomerleau, M. Speechley, L.L. Pederson, and K.N. Speechley (1995). Correlates of Body Mass Index in the 1990 Ontario Health Survey. Canadian Medical As-sociation Journal, 152(11): 1811-1817.

Raine, Kim (2004). Overweight and Obesity in Canada: A Popu-lation Health Perspective. <www.cihi.ca>, as of May 30, 2011.

Rashad, Inas (2006). Structural Estimation of Caloric Intake, Exercise, Smoking, and Obesity. NBER Working Paper Se-ries, no. 11957.

Rashad, Inas, Michael Grossman, and Shin-Yi Chou (2005). The Su-per Size of America: An Economic Estimation of Body Mass Index and Obesity in Adults. NBER Working Paper Series, no. 11584.

Rashad, Inas, and Michael Grossman (2004). The Econom-ics of Obesity. The Public Interest 156 (Summer): 104–112.

Statistics Canada (2011a). Summary Tables: Body Mass Index, Overweight or Obese, Self Reported, Adult, By Age Group and Sex. <www.statcan.gc.ca>, as of March 30, 2011.

Statistics Canada (2010b). Food Statistics 2009. Catalogue No. 21-020-X. Ottawa: Statistics Canada.

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